Part 2: Baptism of fire: The Co SHO responds

Ranjit Thambyrajah responds with his account

Photo Credit: The Execution of Maximilian by Edouard Manet, 1867-8, Oil on canvas | The National Gallery

You can read Part One of this story here.


In the Ear Nose and Throat unit at the General Hospital Colombo the new junior doctors are taught two procedures in the first week of their training. These are to manage an epistaxis and to perform a tracheostomy. This is entirely based on one single fact; that the consultants do not have to come to hospital in the middle of the night to manage these two common emergencies. I could not see any other rationale to include tracheostomy on this list as a tracheostomy is a rather difficult operation at the best of times, let alone to perform under local anaesthesia, on a patient cyanosed and struggling for breath. It is not uncommon to have to hold down these patients to keep them still. Though local anaesthesia is used, there is no sedation because sedation itself can kill the patient. The luxury of tracheostomy under general anaesthesia was discovered when we came to UK for training! We were never taken through the step by step surgical training, that is a trainees dream! To be a good surgeon you need two salient qualities; knowledge of anatomy, and the courage to do it. At this stage we practised “you see one and do one”. This practice was passed down the line over the years. After the incident with my friend Jayantha I single handedly changed the practice of performing tracheostomies in dimly lit cubicles with low level wide beds, to only performing them in a safe theatre setting. Jayantha has showed that he had both qualities in abundance; the baptism he received that day eventually made him not just an ENT surgeon but an ENT head and neck surgeon specialising in Thyroid and Parotid surgery. The complications of these two procedures, damage to the recurrent laryngeal nerve and to the facial nerve have devastating consequences to the patient. I have seen this happening even in the UK, resulting in litigations ending up in compensation rising to tens of thousands of pounds.

This also reminds me of a famous block night caption by Shanthaumar replying to the thyroid surgeon “everything is fine sir but I cannot speak anymore” where the whole audience erupted into roars of laughter. I am proud of Jayanthas' baptism that day, which eventually made him into an accomplished consultant ENT head and neck surgeon. Due to some strange coincidence we both ended up practicing in the same region of the United Kingdom. Those lucky East Anglians!

I am aware that Jayantha re-tells this experience to his young trainees, and refers to me as his guru who works in Luton, but Jayantha for me you are my friend rather than guru.


Ranjit Thambyrajah.


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